Instrumental variables in the cost of illness featuring type 2 diabetes.

IF 3.1 2区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Kyle Kole, Cathleen D Zick, Barbara B Brown, David S Curtis, Lori Kowaleski-Jones, Huong D Meeks, Ken R Smith
{"title":"Instrumental variables in the cost of illness featuring type 2 diabetes.","authors":"Kyle Kole, Cathleen D Zick, Barbara B Brown, David S Curtis, Lori Kowaleski-Jones, Huong D Meeks, Ken R Smith","doi":"10.1111/1475-6773.14412","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To ascertain how an instrumental variables (IV) model can improve upon the estimates obtained from traditional cost-of-illness (COI) models that treat health conditions as predetermined.</p><p><strong>Study setting and design: </strong>A simulation study based on observational data compares the coefficients and average marginal effects from an IV model to a traditional COI model when an unobservable confounder is introduced. The two approaches are then applied to real data, using a kinship-weighted family history as an instrument, and differences are interpreted within the context of the findings from the simulation study.</p><p><strong>Data sources and analytic sample: </strong>The case study utilizes secondary data on type 2 diabetes mellitus (T2DM) status to examine healthcare costs attributable to the disease. The data come from Utah residents born between 1950 and 1970 with medical insurance coverage whose demographic information is contained in the Utah Population Database. Those data are linked to insurance claims from Utah's All-Payer Claims Database for the analyses.</p><p><strong>Principal findings: </strong>The simulation confirms that estimated T2DM healthcare cost coefficients are biased when traditional COI models do not account for unobserved characteristics that influence both the risk of illness and healthcare costs. This bias can be corrected to a certain extent with instrumental variables. An IV model with a validated instrument estimates that 2014 costs for an individual age 45-64 with T2DM are 27% (95% CI: 2.9% to 51.9%) higher than those for an otherwise comparable individual who does not have T2DM.</p><p><strong>Conclusions: </strong>Researchers studying the COI for chronic diseases should assess the possibility that traditional estimates may be subject to bias because of unobserved characteristics. Doing so may be especially important for prevention and intervention studies that turn to COI studies to assess the cost savings associated with such initiatives.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":""},"PeriodicalIF":3.1000,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Health Services Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/1475-6773.14412","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
引用次数: 0

Abstract

Objective: To ascertain how an instrumental variables (IV) model can improve upon the estimates obtained from traditional cost-of-illness (COI) models that treat health conditions as predetermined.

Study setting and design: A simulation study based on observational data compares the coefficients and average marginal effects from an IV model to a traditional COI model when an unobservable confounder is introduced. The two approaches are then applied to real data, using a kinship-weighted family history as an instrument, and differences are interpreted within the context of the findings from the simulation study.

Data sources and analytic sample: The case study utilizes secondary data on type 2 diabetes mellitus (T2DM) status to examine healthcare costs attributable to the disease. The data come from Utah residents born between 1950 and 1970 with medical insurance coverage whose demographic information is contained in the Utah Population Database. Those data are linked to insurance claims from Utah's All-Payer Claims Database for the analyses.

Principal findings: The simulation confirms that estimated T2DM healthcare cost coefficients are biased when traditional COI models do not account for unobserved characteristics that influence both the risk of illness and healthcare costs. This bias can be corrected to a certain extent with instrumental variables. An IV model with a validated instrument estimates that 2014 costs for an individual age 45-64 with T2DM are 27% (95% CI: 2.9% to 51.9%) higher than those for an otherwise comparable individual who does not have T2DM.

Conclusions: Researchers studying the COI for chronic diseases should assess the possibility that traditional estimates may be subject to bias because of unobserved characteristics. Doing so may be especially important for prevention and intervention studies that turn to COI studies to assess the cost savings associated with such initiatives.

以 2 型糖尿病为特征的疾病成本中的工具变量。
目的:确定工具变量(IV)模型如何改进传统疾病成本(COI)模型得出的估计值:确定工具变量(IV)模型如何改进将健康状况视为预设因素的传统疾病成本(COI)模型所得出的估计值:一项基于观察数据的模拟研究比较了在引入不可观察混杂因素时,IV 模型与传统 COI 模型的系数和平均边际效应。数据来源和分析样本:该案例研究利用有关 2 型糖尿病(T2DM)状况的二手数据来研究该疾病的医疗成本。这些数据来自 1950 年至 1970 年间出生的犹他州居民,他们都有医疗保险,其人口信息包含在犹他州人口数据库中。这些数据与犹他州所有纳税人索赔数据库中的保险索赔相关联,用于分析:模拟证实,如果传统的 COI 模型没有考虑到影响患病风险和医疗成本的未观察特征,那么估计的 T2DM 医疗成本系数就会出现偏差。利用工具变量可以在一定程度上纠正这种偏差。根据使用有效工具的IV模型估算,45-64岁的T2DM患者2014年的医疗费用比没有T2DM的可比患者高27%(95% CI:2.9%-51.9%):研究慢性病 COI 的研究人员应评估传统估算值是否可能因未观察到的特征而存在偏差。这样做对预防和干预研究尤为重要,因为这些研究会利用 COI 研究来评估与这些措施相关的成本节约情况。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Health Services Research
Health Services Research 医学-卫生保健
CiteScore
4.80
自引率
5.90%
发文量
193
审稿时长
4-8 weeks
期刊介绍: Health Services Research (HSR) is a peer-reviewed scholarly journal that provides researchers and public and private policymakers with the latest research findings, methods, and concepts related to the financing, organization, delivery, evaluation, and outcomes of health services. Rated as one of the top journals in the fields of health policy and services and health care administration, HSR publishes outstanding articles reporting the findings of original investigations that expand knowledge and understanding of the wide-ranging field of health care and that will help to improve the health of individuals and communities.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信